From the Guidelines
Interstitial cystitis (IC) is a heterogeneous clinical syndrome characterized by bladder/pelvic pain and pressure/discomfort associated with urinary frequency and strong urge to urinate.
Key Symptoms
- Pain (including sensations of pressure and discomfort) is the hallmark symptom of IC/BPS, which can be described as suprapubic pain or pressure related to bladder filling, as well as pain throughout the pelvis and in extragenital locations 1
- Urinary urgency and frequency are also common symptoms, but are not exclusive to IC/BPS and can be found in other lower urinary tract disorders 1
Definition
The American Urological Association (AUA) defines IC/BPS as "an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes" 1
Pathophysiology
The exact cause of IC/BPS is unknown, but it is thought to be a bladder pain disorder that may be associated with voiding symptomatology and other systemic chronic pain disorders, and may be part of a more generalized systemic disorder 1
From the Research
Definition and Symptoms of Interstitial Cystitis (IC)
- Interstitial cystitis (IC) is a heterogeneous chronic disease of unknown etiology that impacts a large number of women, characterized by pelvic pain exacerbated by bladder filling, and associated with lower urinary tract symptoms such as frequency and urgency 2.
- IC is also known as bladder pain syndrome (IC/BPS), a chronic pelvic pain syndrome related to the urinary bladder 3.
- The symptoms of IC are highly variable and can range from moderate discomfort to severe, debilitating pain, accompanied by nocturia, diurnal urinary frequency, and urgency 4.
Pathophysiology and Etiology
- The pathophysiology of IC is incompletely understood, but theories include the breakdown of the glycosaminoglycan (GAG) layer, altered permeability of the urothelium, uroinflammation, and neural up-regulation 5.
- Mast cell activation, altered bladder epithelial permeability, and sensory afferent nerve up-regulation are also thought to play key roles in the development of IC 6.
- The etiology of IC is unknown, but recent theories include the role of an antiproliferative factor 6.
Diagnosis and Treatment
- The diagnosis of IC is often delayed due to a low index of suspicion, and is made from the combination of symptoms, cystoscopic findings, and bladder biopsies 6.
- Treatment options for IC are varied and include behavioral changes, oral medications, intravesical instillation of drugs, and more invasive techniques 3.
- Current guidelines recommend a personalized and progressive approach to treatment, starting with conservative options and advancing to more invasive treatments as needed 2, 3.